Peri‐Procedural Management of Oral Anticoagulant Therapy in Patients Undergoing Percutaneous Coronary Intervention: Insights from the PERSEO Multicenter Registry

Stefano Rigattieri; Ernesto Cristiano; Salvatore De Rosa; Paolo Calabrò; Giovanni Paolo Talarico; Bernardo Cortese; Marco Caruso; Marco Redivo; Alessandro Sciahbasi

doi:10.1002/ccd.31657

June 4, 2025Catheterization and Cardiovascular Interventions

Peri‐Procedural Management of Oral Anticoagulant Therapy in Patients Undergoing Percutaneous Coronary Intervention: Insights from the PERSEO Multicenter Registry

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Why the study?

The optimal peri-procedural management strategy for patients on oral anticoagulant therapy undergoing percutaneous coronary intervention remains debated.

Does the peri-procedural management strategy of oral anticoagulant therapy affect in-hospital bleeding and thromboembolic events in patients undergoing percutaneous coronary intervention?

Structured PICO

Does the peri-procedural management strategy of oral anticoagulant therapy affect in-hospital bleeding and thromboembolic events in patients undergoing percutaneous coronary intervention?

P

Population

763 patients on oral anticoagulant therapy (OAT) undergoing percutaneous coronary intervention (PCI), of whom 76% were receiving direct oral anticoagulants (DOACs) and 24% were on vitamin K antagonists (VKAs).

I

Intervention

Peri-procedural management strategies for oral anticoagulant therapy: uninterrupted OAT, interrupted OAT, or interrupted OAT with bridging therapy.

C

Comparator

The three peri-procedural management strategies were compared against each other.

O

Outcome

In-hospital outcomes including major adverse cardiac and cerebrovascular events (MACCE), bleedings, and thromboembolic events.safety

Implication

In patients on oral anticoagulants undergoing PCI, interrupting anticoagulation appears safe regarding thromboembolic risk and reduces bleeding compared to bridging or uninterrupted strategies.

Abstract

BACKGROUND: The optimal management of patients on oral anticoagulant therapy (OAT) undergoing percutaneous coronary intervention (PCI) remains debated. There are three possible strategies: performing the procedure on OAT, bridging OAT with heparins or stopping OAT. METHODS: In this sub-analysis of the PERSEO multicenter registry, we selected a cohort of patients on OAT undergoing PCI and we appraised in-hospital outcomes according to three different peri-procedural strategies: uninterrupted OAT, interrupted OAT, and interrupted OAT with bridging therapy. RESULTS: The study population consisted of 763 patients, of whom 76% were receiving direct oral anticoagulants (DOACs) whereas the remaining were on vitamin K antagonists (VKAs). OAT was interrupted in 70%, bridged in 24% and continued in 6% of patients, the latter mainly undergoing emergent procedures. The overall rates of major adverse cardiac and cerebrovascular events and bleedings were 1.7% and 6.8%, respectively. The overall rate of thromboembolic events was very low (0.1%), even in patients who interrupted OAT (0.2%). Bridging strategy (OR 2.39, 95% CI 1.12-5.09), increasing age (OR 1.07, 95% CI 1.02-1.12) and white blood cell count (OR 1.17, 95% CI 1.07-1.27) were independently associated with bleedings, whereas radial approach was a protective factor (OR 0.36, 95% CI 0.17-0.77). Continued anticoagulation (bridging therapy or OAT) was also an independent predictor of bleedings (OR 2.22, 95% CI 1.21-4.08). CONCLUSIONS: In this study, OAT interruption was a safe strategy for both bleedings and thromboembolic events, whereas continued anticoagulation, especially bridging, was associated with increased bleeding rate. Radial approach should be preferred in this clinical setting. TRIAL REGISTRATION: The PERSEO study was registered on ClinicalTrials.gov with the ID NCT03392948 (last update 2022-07-22).